Can clubfoot be fixed?

Clubfoot is a common congenital foot deformity. Clubfoot can be fixed with the Ponseti method of stretching and casting and with surgery.
Clubfoot is a common congenital foot deformity. Clubfoot can be fixed with the Ponseti method of stretching and casting and with surgery.

Clubfoot is a fairly common congenital (present at birth) foot deformity. Approximately one infant in every 1,000 live births gets it.

Clubfoot can be fixed if its treatment begins within the first week or two after birth. The condition, however, tends to come back (relapse) but is rare after four years of age. Children with stiff, severe clubfeet and small calf muscle sizes are more likely to suffer from clubfeet after some time even after the treatment. Despite good correction of the condition, children who grow into heavy adults have greater chances to suffer from painful stiff feet.

What causes clubfoot?

Clubfoot describes a foot abnormality in which the baby’s foot points downward and inward so that the toes point toward the opposite leg. The tissues connecting the muscles to the bone (tendons) are shorter than normal in this foot condition.

What causes clubfoot is not exactly known. It is believed to be a combination of genetic and environmental factors.

Clubfoot tends to run in families and it is more common in boys.

Clubfoot can be detected during the 20th week of pregnancy. But the congenital nature of the condition is not due to the abnormal position of the baby in the womb. It is more of a genetic cause.

What is the treatment of clubfeet?

Clubfoot can impair the child’s ability to walk normally if treatment is not initiated aggressively before the second week of life.

The doctor can recommend any of the following treatments

  • Ponseti method (stretching and casting)
  • Surgery

Ponseti method

Ponseti method is the initial line of therapy for clubfoot and it is effective most of the time.

The doctor will align the foot and position it in the normal direction and put it in a long leg (just below the hip to toe) cast. A cast is a special stiff plaster that is wrapped around the leg to secure the foot in its place.

The cast is changed once a week for six to eight weeks. Each week the leg is stretched and repositioned and casting is repeated until the foot is largely improved. The doctor may make the baby wear a brace, which is a bar with a special shoe or boot at the lower end. This helps prevent the foot from twisting again.

Achilles tenotomy is a minor surgical procedure and is usually considered as a part of the Ponseti method. In this procedure, the doctor will cut a part of the child’s tight Achilles tendon (present in the back of the lower leg) to loosen it. This is again followed by casting the leg. The cast is removed after three weeks, by which time the tendon regrows, thereby correcting the clubfoot.

Surgery

If clubfoot is severe or doesn’t respond to nonsurgical treatments, surgery may be needed. The surgeon can use any of the following surgeries to repair the condition

  • Less extensive surgery will involve releasing the Achilles tendon or moving the tendon from the front to the middle part of the leg.
  • Major reconstructive surgery for clubfoot involves the extensive release of multiple soft tissue structures of the foot. 

After the surgery, the child needs to wear a cast for two months. After the removal of the cast, the child is put in braces for several years with gaps in between. Bracing is an important aspect of the aftercare and problems tend to happen because of improper care while carrying the brace. Make sure the child follows all of the doctor’s instructions regarding the maintenance of bracing.

Surgery is successful in most cases. Follow-up surgery may be needed later.

The child can walk, run, play and wear shoes and lead an active, normal life. But some kind of deformity may persist. The affected foot and the calf muscles of the clubfoot leg may remain shorter than those of the healthy foot. Because of this, the child may complain of sore muscles and get tired sooner than other children. The affected leg might also be slightly shorter than the non-clubfoot leg.

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Medically Reviewed on 2/3/2021
References
Medscape Medical Reference

American Academy of Orthopaedic Surgeons